Long term bowel function after repair of anorectal malformations in Uganda

Oyania, Felix; Ogwal, Alfred; Nimanya, Stella; Muzira, Arlene; Kakembo, Nasser; Kisa, Phyllis; Sekabira, John

doi:10.1016/j.jpedsurg.2019.11.015

Cited by 17 publications

(8 citation statements)

References 18 publications

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“…The Rintala questionnaire, for children older than 3 years, consists of seven parameters: the ability to hold back defecation, feeling/reporting an urge to defecate, frequency of defecation, soiling, fecal incontinence, constipation, and social problems (Figure 2) (6). Patients were classified into four categories according to their scores, as follows: normal (18-20), good (12-17), fair (7)(8)(9)(10)(11), and poor (0-6) (19,20).…”

Section: Evaluation Of Defecation Functionmentioning

confidence: 99%

Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function

Feng

Chen

et al. 2023

Front. Pediatr.

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BackgroundThe need to search for ganglia in the terminal rectum/fistula of complex anorectal malformations (ARMs) remains controversial. This study aims to evaluate the relationship between ganglia absence in the terminal rectum/fistula and defecation function after anoplasty.MethodsA retrospective review of patients who received anoplasty for treating male imperforate anus with rectobulbar (RB)/rectoprostatic (RP) fistulas at a tertiary pediatric hospital was conducted with registered demographic data, imaging study results, and information on the terminal rectum/fistula specimen (excision extension and pathological findings). According to the pathological findings, patients were divided into Groups 1 (ganglia absence) and 2 (ganglia presence). Furthermore, the postoperative defecation function was evaluated using various rating scale questionnaires. Statistical analysis was performed using SPSS 22.0.ResultsOf the 62 patients, 18 (29.0%) showed ganglia absence in the terminal rectum/fistula. By analyzing the imaging data, spinal anomalies and spinal cord anomalies were found in 30.6% (19/62) and 56.5% (35/62) of patients, respectively. Baseline information was comparable between Groups 1 and 2 (P > 0.05). For defecation function, there were no significant differences in Kelly scores between the two groups (4.0 ± 0.8 vs. 4.4 ± 1.1, P = 0.177), while Krickenbeck (3.7 ± 1.8 vs. 5.2 ± 1.4) and Rintala (13.7 ± 3.6 vs. 16.0 ± 2.7) scores in Group 1 were significantly lower than those in Group 2 (both P < 0.05). The overall incidence of constipation was 50% (31/62), being higher for Group 1 than Group 2 (77.5% vs. 38.6%, P = 0.002). The area under the curve of ganglia absence for predicting constipation was 0.696, with 77.8% sensitivity and 61.4% specificity.ConclusionGanglia absence in the terminal rectum/fistula of male imperforate anus with RB/RP fistulas is associated with constipation after anoplasty, but it has limited predictive value for postoperative constipation. It is necessary to search for ganglia in the terminal rectum/fistula, both intraoperatively and postoperatively.

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Section: Evaluation Of Defecation Functionmentioning

confidence: 99%

Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function

Feng

Chen

et al. 2023

Front. Pediatr.

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“…Primary outcome measures were AMCP, ALCT, RRP, and ARP. The clinical outcome was evaluated by the RBFS (1,12,13).…”

Section: Outcome Measurementmentioning

confidence: 99%

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

Yuan

Yang

et al. 2021

Front. Pediatr.

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Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it.Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP).Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant (P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions (P < 0.05).Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

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“…In Africa, ARMs are one of the most common congenital anomalies, and a leading congenital cause of intestinal obstruction in infants (3,4). ARMs account for 24.7% of all neonatal congenital malformations (5), and nearly 63% of these are diagnosed after the rst 48 hours of life (2). More than two-thirds of cases are high ARMs, and most receive delayed surgical repair, at a median age of 11 months (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Quality of Life of Children After Completion of Surgical Treatment for Anorectal Malformation: A Single-Centre Cross-Sectional Study in South-Western Uganda

Mucunguzi,

Oyania,

Egesa

et al. 2023

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Background Anorectal malformations (ARMs) range from minor abnormalities such as imperforate anus to complex forms such as cloaca, and are often associated with other anomalies and residual functional stooling problems. The present study aimed to evaluate the quality of life (QoL) of children after surgical treatment for ARMs at Mbarara Regional Referral Hospital (MRRH) in South-Western Uganda. Methods In this cross-sectional study, we enrolled children who had completed surgical treatment for ARMs between 2014 to 2021 at MRRH. A 23-item PedsQL 4.0 inventory was used to evaluate health-related QoL in children using a multidimensional parent proxy reporting for children aged 3 months to 7 years and child self-reporting for children aged 8 to 17 years. Regression analysis was used to determine the association between sociodemographic and clinical variables and QoL. Crude and adjusted coefficients and their corresponding 95% confidence intervals (CI) were calculated. The significance level was set to a p-value < 0.05. Results A total of 88 participants (F:M ratio = 1.15:1) aged 3 months to 18 years with a median age of 4.5 (IQR 3–7) years were enrolled. The median age at diagnosis of ARM and preliminary diverting colostomy was 3 days (range: 2 to 30 days) and 3 days (range: 2 to 60 days) respectively. Rectovestibular fistulas, 47 (53.4%) were the most prevalent subtype of ARMs, and 5.7% of children had associated anomalies. Over one-third of the participants (38.6%) had definitive surgery after 3 years of age, and PSARP was the most common procedure. The average PedsQL score was 94 out of a maximum score of 100. The mean physical functioning score was 96.7 in males and 98.9 in females. The overall mean emotional functioning score was 91 ± 2. The mean social functioning score was 92 ± 3.0. The mean school functioning score was 95.7 in males and 98.5 in females. Associated anomalies and reoperation significantly predicted poor QoL. Increasing years after completion of surgery was significantly associated with good QoL scores. Conclusion The overall QoL of the participants was good. Associated anomalies and reoperation were associated with poor QoL, while years after completion of definitive surgery was associated with good QoL. There is need for increased awareness and utilization of QoL assessments as an outcome measure after definitive surgery for ARM.

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Long term bowel function after repair of anorectal malformations in Uganda

Cited by 17 publications

References 18 publications

Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function

Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

Quality of Life of Children After Completion of Surgical Treatment for Anorectal Malformation: A Single-Centre Cross-Sectional Study in South-Western Uganda

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